IgA Vasculitis in a Patient on Dialysis

Main Article Content

Deepak Kumar Chitralli
Brian Mark Churchill
Pallavi Patri
Divya Puttegowda

Abstract

Immunoglobulin A vasculitis (IgA Vasculitis), formerly called Henoch Schonlein Purpura (HSP) is a common systemic vasculitis in children. It is 33 times less common in adults than in children. Besides having dermatology manifestations in form of rash, it may affect other organs including kidney (nephritis that can lead to chronic kidney disease), arthritis, arthralgia, abdominal pain, bowel angina and gastrointestinal bleeding.

IgA vasculitis may result in IgA vasculitis nephritis (formerly called HSP nephritis). It shares a lot of similarities with IgA nephropathy, but has some notable differences as discussed later.

IgA vasculitis is rare in chronic kidney disease (CKD) patients on dialysis. We present a case of IgA vasculitis in an elderly male with end stage renal disease (ESRD) presumed to be due to diabetic nephropathy (kidney biopsy not available). He developed skin manifestations (rash). Skin biopsy confirmed the presence of IgA vasculitis.

Keywords:
IgA vasculitis, immunoglobulin a vasculitis, Henoch Schonlein Purpura, leukocytoclastic vasculitis, IgA nephropathy.

Article Details

How to Cite
Chitralli, D. K., Churchill, B. M., Patri, P., & Puttegowda, D. (2020). IgA Vasculitis in a Patient on Dialysis. Asian Journal of Research in Nephrology, 3(1), 17-23. Retrieved from https://journalajrn.com/index.php/AJRN/article/view/30096
Section
Case Study

References

Piram M, Mahr A. Epidemiology of immunoglobulin A vasculitis (Henoch-Schönlein): Current state of knowledge. Curr Opin Rheumatol. 2013;25(2):171-8.

DOI: 10.1097/BOR.0b013e32835d8e2a

Yoshino J, Sasamura H, Konishi K, Tsuji M, Suda N, Yoshida T, Monkawa T, Hayashi M, Itoh H. A case of Henoch-Schönlein purpura in a patient on hemodialysis. Nihon Jinzo Gakkai Shi. 2007;49(1):49-53.

Lamikanra O, Obanor S, Tuneev K, Ponnusamy V, Seneviratne C, Yoon TS, Kupfer Y. Presentation of Henoch Schonlein Purpura in an elderly man with end stage renal disease. Chest Journal. 2019;156(4 Supplement):A1300–A1301.

DOI:https://doi.org/10.1016/j.chest.2019.08.1167

López‐Mejías R, Genre F, Pérez BS, Castañeda S, Ortego‐Centeno N, Llorca J, Ubilla B, Remuzgo‐Martínez S, Mijares V, Pina T, et al. Brief report: Association of HLA–DRB1*01 with IgA vasculitis (Henoch‐Schönlein). Arthritis and Rheumatology. 2015;67(3):823-827.

DOI: https://doi.org/10.1002/art.38979

Churchill BM, Kossi ME, Jin JK, Sharma A, Halawa A. Understanding human leukocyte antigen typing and crossmatch techniques in renal transplantation. British Journal of Renal Medicine. 2017;22(4): 115-121.

López-Mejías R, Genre F, Pérez BS, Castañeda S, Ortego-Centeno N, Llorca J, Ubilla B, Remuzgo-Martínez S, Mijares V, Pina T. Association of HLA-B*41:02 with Henoch-Schönlein Purpura (IgA vasculitis) in Spanish individuals irrespective of the HLA-DRB1 status. Arthritis Research & Therapy. 2015;17(1):102.

DOI:https://doi.org/10.1186/s13075-015-0622-5

Ueda H, Miyazaki Y, Tsuboi N, et al. Clinical and pathological characteristics of elderly Japanese patients with IgA vasculitis with nephritis: A case series. Intern Med. 2019;58(1):31–38.

DOI: 10.2169/internalmedicine.1379-18

Patri P, Churchill BM, Ghosh RP. Vaccines for kidney transplant recipients: Efficacy considerations and recommendations. British Journal of Renal Medicine. 2019;24(1):21-27.

Davin JC, Berge IJT, Weening JJ. What is the difference between IgA nephropathy and Henoch-Schönlein purpura nephritis? Kidney International. 2001;59(3):823– 834.

Shimizu H. Vasculitis, purpura and other vascular diseases. In: Shimizu H. Shimizu's Textbook of Dermatology. Sapporo, Japan: Hokkaido University Press/Nakayama Shoten. 2007;135-139.

Available:https://www.derm-hokudai.jp/shimizu-dermatology/pdf/11-01.pdf

(Accessed on: 1 March 2020)

Calvo-Río V, Loricera J, Ortiz-Sanjuán F, Mata C, Martín L, Alvarez L, González-Vela MC, Rueda-Gotor J, González-López MA, Armesto S, et al. Revisiting clinical differences between hypersensitivity vasculitis and Henoch-Schönlein purpura in adults from a defined population. Clin Exp Rheumatol. 2014;32(3 Suppl 82):S34-40.

González-Gay MA, López-Mejías R, Pina T, Blanco R, Castañeda S. IgA vasculitis: Genetics and clinical and therapeutic management [Abstract]. Curr Rheumatol Rep. 2018;20(5):24.

DOI: 10.1007/s11926-018-0735-3

Egan CA, Taylor TB, Meyer LJ, Petersen MJ, Zone JJ. IgA1 is the major IgA subclass in cutaneous blood vessels in Henoch-Schönlein purpura. Br J Dermatol. 1999;141(5):859‐862.

DOI: 10.1046/j.1365-2133.1999.03159.x

Gota CE, Calabrese LH. Diagnosis and treatment of cutaneous leukocytoclastic vasculitis. Int. J. Clin. Rheumatol. 2013;8(1):49–60.

Churchill BM, Patri P, Cama R, Inrig JK. TNF-α, TNF receptors and their complex implications in therapy. Asian Journal of Immunology. 2020;4(1):36-50.

Available:http://www.journalaji.com/index.php/AJI/article/view/30127